Weaving together personal stories with powerful facts, journalist Linda Villarosa discussed the impact of racism in health care and strategies for the future at the February 12th Dean’s Lecture “Storytelling for Social Justice and Health”.
The event was held at the Yale School of Public Health Winslow Auditorium and co-sponsored by the Poynter Fellowship in Journalism at Yale which aims to provide a cultivated look at topics of interest from different perspectives. Fellows are invited to deliver lectures and meet with faculty and students, allowing participants to gain unique insight into the media and its role in contemporary culture.
Villarosa is a former executive editor of Essence Magazine and a contributing writer for The New York Times Magazine where she covers race, inequality, and public health. During her introduction, YSPH Dean Megan L. Ranney, MD, emphasized the importance of communication as one of the core pillars of public health and stressed the need to effectively translate science into actionable insights for individuals, families, and communities. She also spoke about the power of storytelling specifically, explaining, “It's the stories that situate the facts and that give us that kind of personal grounding and reminder about why we're doing this.”
Villarosa’s presentation began with a discussion on the current state of health care inequality. “Even if everyone had access to health care in our country, we would still have inequality in many areas and the one I have studied the most is race,” she said. An author and educator, in 2018 Villarosa stirred a national conversation about maternal and infant mortality and health disparities among Black women after publishing a New York Times Magazine article titled, “Why America’s Black Mothers and Babies are in a Life or Death Crisis”. In 2022 her book, “Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation”, was named a best book by six media outlets including NPR, the Atlantic, and the Washington Post. It was honored as one of the top 10 books of 2022 by The New York Times Book Review and was a finalist for the 2023 Pulitzer Prize.
Villarosa elaborated on the negative health outcomes for Black Americans stating, “We live sicker and die quicker. It starts at the beginning of life and goes all the way to the end.” She then provided information on the various myths and misconceptions that have been cited as the source behind racial health disparities in the United States including poverty, perceived physiological differences, negative health habits as a demographic, and stereotypes. Villarosa explained that many of these misconceptions are still prevalent, and racism plays a direct and indirect role in inequality in health care. She provided three main areas to explain these negative health outcomes: a term called ‘weathering’, social determinants of health, and discrimination in the health care system itself.
We live sicker and die quicker. It starts at the beginning of life and goes all the way to the end.
Linda Villarosa, author, on the negative health outcomes of Black Americans
In the 2023 book “Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society”, Dr. Arline T. Geronimus, a professor at the University of Michigan School of Public Health, coined the term “weathering” to describe the effects of systemic oppression—including racism and classism—on the body, referencing more than 30 years of research. Weathering suggests day-to-day causes of wear and tear on the body can result in premature aging “the same way a storm might weather a house”. Villarosa explored this concept through personal stories about her own childhood and her pregnancy with her daughter who was born at a low-birth rate. She said, “I think about that in my own family, was I a person who experienced weathering?”
The next area that Villarosa referenced was social determinants of health, referring to the environment where people live and their access to positive or negative health contributors. Negative determinants of health include situations such as lack of access to healthy food, clean air and water, safe places to exercise, housing that is safe, and security and safety in general. “Communities of color are more likely to live in a community that is historically redlined,” Villarosa said. “One that doesn't have good social determinants of health and doesn't have all those safeties.” Drawing from examples in her own life, Villarosa detailed her experiences with social determinants of health. She shared a story about her grandfather who feared he would lose his home because of a housing practice called “contract buying”.
The third area Villarosa identified as a contributor to health inequalities was discrimination in the health care industry itself. She referenced the 2003 book “Unequal Treatment” by the Institute of Medicine (U.S.) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. According to the National Library of Medicine, the book documents “increasing evidence [that] race and ethnicity remain significant predictors of the quality of health care received.” In the book, according to a summary provided by the National Library, “experts … explore how persons of color experience the health care environment … patients' and providers' attitudes, expectations, and behavior are analyzed.” Villarosa again shared a personal story about a negative experience she had when seeking medical care for her father and the extra steps she felt she had to take to ensure he was treated properly. She asked, “Why did we have to show this respectability just to get good care?”
At the end of her presentation, Villarosa shifted her commentary toward solutions and next steps. One area of progress she referenced was a piece of California legislation known as the “California Dignity in Pregnancy and Childbirth Act”, that was signed into law in 2019. The law aims to decrease Black maternal deaths. With the implementation of this law, physicians are required to complete evidence-based bias training at a minimum of every two years. Additionally, it empowers patients by requiring hospitals to let patients know of their right to be treated fairly and without discrimination and how to file a complaint if they feel this right has been violated.
During the audience Q&A, Villarosa discussed how students could contribute to change in public health, at Yale and beyond. She highlighted organizations and activist groups such as White Coats for Black Lives and the Institute for Healing & Justice in Medicine, and shared her own experience with students while showing them a picture of her premed class at CUNY. “I taught premed last year, and these are my students, and I see a lot of hope in the next generation of health care providers, including many of you,” said Villarosa.
Following her presentation, Villarosa sat down with Dean Ranney for a brief fireside chat moderated by Dr. Neal Baer, a lecturer in the Department of Chronic Disease Epidemiology (CDE) and co-director of the master’s degree program in Media, Medicine, and Health at Harvard Medical School. An award-winning showrunner, television writer, producer, physician, and author, Baer brought the conversation back to the power of narrative in health by asking how schools of medicine and public health can engage artists and storytelling. Villarosa responded, “I think part of the work is starting with the community and letting people tell their own stories.”
This event was co-coordinated by the YSPH Department of Chronic Disease Epidemiology (CDE) and Judith Litchman, department chair and Susan Dwight Bliss Professor of Epidemiology (Chronic Diseases). Villarosa spoke to Professor Lichtman’s CDE Humanities, Arts, and Public Health (HAPPY) class following the lecture.